醫師與護理師使用巴氏量表之一致性探討

Inter-rater Reliability of Functional Assessment Using Barthel Index Between Nurses and Physicians

林瑛釗(Ying-Chao Lin)

指導教授 ： 戴玉慈

國立臺灣大學/醫學院/護理學研究所/碩士(2015年)

https://doi.org/10.6342/NTU.2015.01082

摘要

研究背景：巴氏量表為目前台灣地區用來評估日常生活活動功能狀態最廣為運用的評估量表，舉凡長期照護機構收治失能長者之功能評估內容、失能者申請政府照顧人力協助與補助，或是聘雇外籍看護工之評估皆以巴氏量表的評估結果為依據。臨床上，藉由不同時期之日常生活活動功能評估，也能提供醫療團隊了解病人進步的方向與後續照護之規劃，因此，不同職類人員對於巴氏量表的評估若具有一致性，更有助於團隊間的溝通，提供病人最佳的復健目標設定，而巴氏量表於研究應用上，更是國內相關研究用以評估日常生活活動功能常用之評估量表，但是綜觀國內之研究卻缺乏了探討醫師與護理師評估巴氏量表一致性之相關研究。
研究目的：本研究期望能藉由收集評估者與被評估者之相關資料，了解評估者以巴氏量表進行日常生活活動功能評估之ㄧ致性。
研究方法：本研究以北部某醫學中心之復健科病房進行資料收集，以實際上參與病人照護之住院醫師與護理師為日常生活活動功能之評估者，入住或轉入復健病房之病人為被評估者，以結構式問卷調查病人與照顧者之基本資料，病人資料包括年齡、診斷、性別、教育程度與MMSE分數；照顧者資料包括年齡、照顧病人的時間、性別與教育程度；評估者則收集年齡、性別、本院工作年資、職級與接受過巴氏量表評估在職教育時數等資料進行描述性與推論性之統計。
研究結果：本研究收案期間自2014年8月至2014年9月，共收集67對病人與照顧者、住院醫師15名、護理師20名。醫師與護理師進行病人ADL之評估總分具有良好之一致性(ICC=0.95)，而巴氏量表的各分項目中，僅「個人衛生」、「如廁」、「洗澡」與「平地走動」等四個項目屬中等一致性(K=0.49~0.55)，其餘六項「進食」、「移位」、「上下樓梯」、「穿脫衣褲」、「大便控制」與「小便控制」具有良好的一致性(K＞0.60)。
結論：本研究證實醫師與護理師使用巴氏量表進行日常生活活動功能評估具有良好的評估者間一致性，希望此研究結果有助於了解醫師與護理師評估病人ADL差異之相關原因，並提供巴氏量表評估時之操作指引，做為臨床評估之參考。

關鍵字

巴氏量表 ； 評估者間一致性 ； 功能評估

並列摘要

Background: Currently, the Barthel Index (BI) scale of activities of daily living (ADLs) is the most widely used scale for functional assessment of disabled elderly under long-term care in Taiwan. The disabled elderly require government assistance and grants for getting hospitalized or using foreign health aids or in case of loss of caretakers. Clinically, the BI scores help select further treatment plans and improve the patients’ ADLs; using data from varying assessment periods, the scores could also improve communication among the therapeutic teams. Therefore, if the results of the BI assessment obtained by the staff from various disciplines are consistent, the interdisciplinary communication can be improved, thus providing the best setting for rehabilitation. However, there is a lack research comparing the interrater reliability of functional assessment of ADLs between nurses and doctors.
Objective: To evaluate the consistency in the results of the BI assessment determined by the staff from various disciplines and to functionally assess relevant information collected from the assessor and assessee.
Methods: Information was collected from the rehabilitation ward of a medical center in the northern part of Taiwan. The assessors of functional activities of ADLs were the doctors and nurses that were currently in-charge of hospitalized patient care. The assessees were patients admitted or transferred to the rehabilitation ward. Basic information of the patient and caregiver was obtained using a structured questionnaire: for patients: age, diagnosis, sex, education level, and MMSE scores; for caregivers: age, duration of care, sex, and education level. For the assessors, information regarding their age, sex, duration of service at the present hospital, seniority, designation, and knowledge of the in-services for the BI assessment was collected. This data were analyzed using descriptive and inferential statistics.
Results: In a cross-sectional survey, conducted from August 15 to September 30, 2014, 67 pairs of patients and caregivers, 15 resident physicians, and 20 nurse practitioners participated. The result of the total BI scores evaluated by physicians and nurses was fairly consistent (ICC = 0.95). The scores of “grooming,” “toilet,” “bathing,” and “ambulation,” the sub-items of the BI, were moderately consistent (K= 0.49–0.55). The scores of the remaining six sub-items, “feeding,” “transfer,” “climbing up and down the stairs,” “dressing,” “bowel movement,” and “bladder,” were fairly consistent (K ≥ 0.60).
Conclusion: The evaluation of the patients’ functional ADLs by physicians and nurses using BI showed good interrater reliability. The results of this study can help in inferring the reasons for different assessment scores obtained from the physicians and nurses, thus offering operator guidance regarding BI for clinical reference.

並列關鍵字

Barthel Index ； interrater reliability ； functional assessment.

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